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Vanguard20

Scar Treatment suggestions

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Ok, to start off, I'm a 20yo white male.

I have rolling scars across my cheeks( I mean, all over them) and on my right temple. I have pits also on my right cheek and next to my jaw.

Big problem: Depressions. Just enormous, gradual depressions. One on my right cheek. When I have a single point light aimed toward my face(head on), it greatly disfigures my face with a large shadow that takes up a lot of my right cheek. The there is one on my left cheek as well, but not as dramatic.

What are the best procedures to most efficiently reduce these? For the large depressions(the one on the right is easily an inch wide) I was considering a skin graft...good idea? How much are they?

Perhaps an N-Lite on the cheeks and temple and excise the left scar.

I really don't want fillers as they're mostly temporary(except for Artecoll, but I don't know if it's available in the US yet.

Comments are appreciated.

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Hi, I am sorry but I believe that fillers are really the only practical way to deal with large atrophic areas. You should check into fat transfer or Sculptra. Perlane is also in clinical trials and should be available soon in the U.S. if that's even your country. I just got Restylane myself and it came out great.

http://www.acne.org/messageboard/index.php...topic=28259&hl=

Excision may be bad because it will leave a rough scar unless you get it resurfaced, and even then it could look bad. Snap us a pic and many people could offer more advice. Good luck

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I agree with dermadude, that's another option that can help some people, especially used right before a filler - good call.

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That's quite incredible improvement, dermadude. I think I'll look into subcision a bit.

What about skin grafts? No good?

Oh, and three more questions:

How much is a subcision + Nlite procedure

Does anyone know of a plastic surgeon in Houston that does it?

Is there *any* way for any of the filler procedures( like autologous fat transfer) to become permanent(ie- multiple treatments)?

Thanks in advance.

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I had dermabrasion done almost 7 weeks ago with Dr. Yarborough in New Orleans. It helped a lot with my rolling scars, my skin looks much smoother in "bad" lighting. I'm very happy I got it done but the only thing is that it is quite spendy. There's also some downtime but I was able to go out with makeup 2 weeks post-op.

Having Dermabrasion with Dr. Y link

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Vanguard20, there is a technique for fat transfer that is permanent. It involves delicately removing an entire string of fat, usually from the abdomen, and implanting it with an existing blood supply. Most doctors cannot properly do this, though. IMHO subcision + Nlite, or dermabrasion alone, will not do a whole lot for large deep scars. Skin grafts could work, but you could end up with 2 scars instead of one. I'm sticking with my original answer. smile.gif

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well, the skin graft was for the large atrophic area. Namely, remove it and place the donor skin in place of it.

Any news at all on Artecoll being approved in the US?

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Ok, I will definetly consider that as well as the subcision/N-lite combo. I'm guessing microdermabrasion follow-up will help to 'mop-up' what's left.

What is the pricing on both the fat transfer and the subcision/N-lite treatments?

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I had artecoll done by Dr. James Romano in San Francisco. He is one of the few approved for the procedure. He took part in the FDA Trials. I only have two scars on one cheek, moderate depth, and artecoll did zero for them. In fact it migrated. I had two cc's worth done over a one year period and had zero results. Dr. Romano claims to see a difference, but I gotta tell you, the guy is full of shit. Typical doctor nonsense. When I questioned the non results he got upset. Imagine, having the temerity to question His Loftiness! For acne scarring, stay very clear of this doctor. He has zero knowledge regarding acne scarring and underneath his superficail affabilty he is a real jerk.

James

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Healtysceptic, that's horrible. I am surprised they didn't have a scientific way to evaluate the efficacy of the filler, or lack thereof, in a clinical trial. I have read some studies that measure atrophic scars using a sort of mask that they peel off.

Permanent fillers are generally a bad idea - I still don't know why people can't seem to wrap their brain around that. I mean people can change their oil and get a haircut at regular intervals, why not have a filler done every year or so?

This article sums it all up, at least in my eyes.

http://www.center4policy.org/artecoll.html

Vanguard20, fat transfers are roughly 1000 US dollars, but that is the kind that last, after 2 or more injections, maybe a year or 2.

If you decide on a subcision/N-lite combo, a microdermabrasion will not be able to mop it up. There would probably be too much left. (At least for the large area you spoke of)

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Well, the 'mopping up' was just in reference to helping to smooth out(at least a little) anything that the Subcision/N-Lite wasn't able to get(say the temples)

Btw, is there a place that thoroughly describes subcisions? Does one penetration only affect ones scar or does it have a bit of a range?

Oh, and is the large atrophic area considered a scar? There is absolutely no way to get rid of it aside for maybe fat transfer? Skin graft is an absolute no-no or just generally a bad idea?

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There is absolutely no way to get rid of it aside for maybe fat transfer? Skin graft is an absolute no-no or just generally a bad idea?

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Sorry, I forgot about that and thought you were talking about excision.

Thank you for the help everyone. I think my overall plan will be to get an N-Lite done to reduce the many shallow scars. From there, several subcision/N-Lite procedures on the deeper scars. The large atrophic areas will be filled with fat which will hopefully end up long term.

That's subject to a lot of change, heh.

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I'd like to ask about how I should treat my scarring also. I have extensive and deep pitted scarring, what is the best way to treat it? To what extent can laser resurfacing reduce scarring; does it work on really severe scarring?

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Hi, I will answer your questions if I can.

what is the best way to treat it? (Deep pitted scarring)

For rolling scars, A combination of fillers and dermabrasion. For icepicks, punch grafts, punch floats, or TCA Cross. Boxcars, I am not sure. They are very difficult to treat.

To what extent can laser resurfacing reduce scarring? Very little. Results usually not permanent.

does it work on really severe scarring? No. There is no medical evidence whatsoever that it does. Most doctors use lasers simply because they are easy and don't spatter blood all around like dermabrasion. Oh yeah, And they can charge a shitload of money, and uneducated patients will pay it. ohmy.gif

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Subcisions or subcisions + N-lite can definitely help, but I would not rate them very high. Smoothbeam has a clinical edge over N-lite, Coolbeam, and the other non-ablative lasers that are out there right now. From my MASSIVE research I have concluded that the best treatments for atrophic acne scars are fillers, punch grafts, punch floats, and dermabrasion. Promising new treatments are also out there such as TCA Cross and needling. (using a tattoo needle or roller with many needles)

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Dermadude--Wow, you're improvement is quite amazing--congratulations to you.

James, I'm really sorry to hear about your disappointment with Dr. Romano. Before my dermabrasion, I went to see him on your recommendation I thought you were really happy with him and his office, especially with regards to CROSS. Also, I thought you said that he thought the artecoll would not in fact work, but wanted to give it a try anyway? Did he change his mind after the fact. In any case, it's a shame, sorry it didn't work out.

--leo

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Oldguy,

the reason why some people dont like temporary fillers is that, you wanna fix your scar and never have to think of it anymore in your life. A permanent filler may last a few years to forever, but as for a temporary filler, if it lasts 1 years, it means that by 6 months you ve lost half of it, and your scar is visible again. And if a scar is .5 mm depth or 3mm, as long as the depression is there, the shadow is almost the same.

i have 2-3 shallow scars, my roomate has a 2 deep ones (somehow he doesnt give a shit about it...), i dont think mine look better than his in any lighting if you look at the whole face instead of focusing on the holes.

I dont call a solution something you have to repeat indefinitly and still have to worry about. I dont wanna have to check my face everymorning to see if my scar is coming back. Im still debating between getting silicone done in NY or bioalcamid in France.

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ManicDepression, I totally understand. You really should consider trying out a filler first though. Maybe a bit of Restylane or collagen would let you at least know how things would look later and if it might migrate. If you're American you should remember that if you have anything done in France you won't have many legal options if anything goes wrong. Bonne chance, monsieur.

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well im French but i study in Montreal, Qc, so it leaves me with several options. there is artecoll here in canada, but from what i ve seen on this forum, it s not that great. A few roundtrips to NY to get some silicone injected would not be that expensive, but silicone would be my second choice due to the potential risk. My parents are looking for an experienced doc in Paris, who can inject bio alcamid properly, so hopefully i ll get it done at christmas. But docs in France dont really like fillers, they seem to prefer dermabrasion or lasers. the punch technique is also fairly new in France. The advantage is that everything is cheaper than in the US.

I ve thought of getting one of those tempora

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